75562 Policy Brief Issue 4 | January 2013 Empowering Adolescent Girls in Uganda Oriana Bandiera, Niklas Buehren, Robin Burgess, Markus Goldstein, Selim Gulesci, Imran Rasul and Munshi Sulaiman Summary The productive potential of adolescent girls in Uganda is critically limited by the reciprocal relationship between low health, education and employment indicators. With little incentive to attain relevant skills training, girls choose to have children early and become engaged in risky behavior, further hampering their ability to generate income. To address these challenges, we evaluated the impact of a BRAC program that simultaneously provided livelihoods training to run small-scale enterprises, and education on health and risky behaviors. After tracking 4,888 girls over a period of two years, we found that the program had strong positive impacts on economic, health and agency outcomes for the girls. The program increased the likelihood of participants engaging in income-generating activities by 32%; self-reported routine condom use by those who were sexually active increased by 50%; fertility rates dropped by 26%; and there was a 76% reduction in adolescent girls reporting having had sex against their will during the past year. THE PROBLEMS GIRLS FACE IN UGANDA income-generating opportunities for adolescent girls to tap into Almost 60% of Uganda’s population is under the age of 20. The will have significant impacts on younger girls facing the same country has one of the highest rates of young women out of the decision-making point. labor force. For those in the labor force, females at all ages have higher unemployment rates than men, and this trend is WHAT CAN BE DONE ABOUT IT? especially pronounced among younger women. Uganda has Many policy interventions have focused exclusively on the second highest child dependency ratio in the world. classroom-based education courses designed to reduce risky Relative to females in the same age range in richer economies, behaviors, or exclusively on livelihood training designed to fertility rates (the number of births per 1,000 women) are three improve employment opportunities for youth. As a body of to four times higher in Uganda, and again, this gap is starkest randomized control trials suggest, these single-pronged for younger women. programs have met with, at best, rather mixed success. It is this breadth of research that has informed this intervention, These adolescent girls are not only struggling with labor force which targeted adolescent girls using a combined life-skills and constraints but are also facing severe health related challenges livelihood training approach. Using this two-pronged approach that make it even more difficult for them to become addresses the inter-linkages between the health and economic economically active. They are dealing with early wedlock, challenges that they face. pregnancy, exposure to STDs, and HIV infection. Teen pregnancy and early marriage limit the ability of these girls to Our evidence indicates that the combined program was more go to school and find gainful employment. Additionally, the lack successful than most interventions that have exclusively of job potential reduces incentives for young girls to attend targeted life skills or livelihood skills in similar contexts. This school and obtain other types of training. As a result, suggests that the individual program elements are adolescent girls get married early and have children early, complementary to each other: girls are more likely to increasing their dependency on older men. This cycle of early internalize health-related education in terms of knowledge and fertility and lower economic outcomes can be curtailed and can behaviors when they are simultaneously offered new income- result in substantial payoffs. Demonstrating that there are generating skills. At the same time, the expected returns to The World Bank Group | Africa Region Gender Practice Policy Brief: Issue 4 1 providing livelihood training to this target population might be establishing small-scale enterprises based on their own larger when girls are simultaneously provided information to environment and the demand for such services. The key topics help reduce their exposure to activities that involve risky covered in the life skills training sessions included sexual and behaviors. Our findings complement a small body of research reproductive health, menstruation and menstrual disorders, that uses large-scale randomized control trials to provide pregnancy, sexually transmitted infections, HIV/AIDS evidence on the links between economic and health awareness, family planning, and rape; other sessions covered challenges. enabling topics such as management skills, negotiation and conflict resolution, and leadership among adolescents. A final 1 THE ELA PROGRAM class of life skills training focused on providing girls with legal The Empowerment and Livelihood for Adolescents (ELA) knowledge on women’s issues such as bride price, child program was designed to improve the cognitive and non- marriage and violence against women. cognitive skills of adolescent girls. The program was developed and is being implemented by the NGO, BRAC, in several countries of Asia and Africa, including Uganda. In contrast to some other school-based information campaigns on adolescent health, the ELA program operated through “adolescent development clubs,� a meeting place within each community that normally included 20-35 girls. Club participation was voluntary and unrelated to engagement with other BRAC activities. Eligibility was based on gender and age: only girls were permitted to participate, and the program was 2 intended for adolescent girls between the ages of 13 and 20. The two forms of skills training provided in the ELA program were life skills training and livelihood training, both of which took place within the clubs. In addition, the clubs also hosted popular recreational activities such as reading, staging dramas, ELA METHODOLOGY singing, dancing and playing games. We evaluated the ELA program in Uganda using a randomized control trial. The evaluation took place during the initial phase Training Types of the program, a it was being rolled out. As part of an earlier The livelihood training included a series of courses on income- program, BRAC had established branch offices throughout the generating activities informed by local market conditions: country: 10 of these branch offices were chosen for the ELA agricultural training on local crops, vegetable cultivation, evaluation. Five branches are located in the urban or semi- poultry rearing, animal vaccinator training, tailoring, other non- urban regions of Kampala and Mukono; the remaining five farm businesses, and community health training. Although branches are located in the mostly rural region around Iganga many of the skills are applicable for either wage or self- and Jinja. In each branch, at least 15 communities with the employment, more focus was placed on the adolescent girls potential to host an ELA club were identified. From this list, 10 locations within each branch office were randomly assigned to 1 The full report on the ELA Program, “Empowering Adolescent Girls: receive the treatment, i.e. to set up a club and deliver the ELA Evidence from a Randomized Control Trial in Uganda,� authored by program, with the remaining five locations randomly assigned Oriana Bandiera, Niklas Buehren, Robin Burgess, Markus Goldstein, as controls and not receiving the program. In each treatment Selim Gulesci, Imran Rasul and Munshi Sulaiman can be retrieved at: http://www.homepages.ucl.ac.uk/~uctpimr/research/ELA.pdf community, a single club was opened up. Hence, the research 2 Given the difficulties of verifying ages in this setting and the demand design involved 100 treatment and 50 control communities. for club activities arising from other girls, in practice some girls outside Within these communities, we surveyed 5,966 girls as well as of the 13-20 age range also attended the clubs. However, these their parents at baseline. In the follow-up survey, we spillovers did not have significant impacts on results presented. interviewed 4,888 girls, resulting in an attrition rate of 18%, Policy Brief Issue 4 | January 2013 which is in line with previous studies dealing with this type of that females should earn money for the family; and (8) an highly mobile population. increase in satisfaction with earnings and income. EFFECTS OF THE ELA PROGRAM COSTS AND BENEFITS The program demonstrated positive impacts on adolescent Because the program increased labor force participation and girls in terms of their economic behaviors, health outcomes and earnings, and reduced risky behaviors, its benefits per their agency and aspirations. participant were much larger than its costs. During the second year, the per-girl incurred cost of the program was $17.90. For Economic Behaviors girls engaged in self-employment at baseline and follow-up, the Prior to the introduction of the program, only 6.5% of girls increase in earnings alone was $32.10. While it is difficult to reported being self-employed. But following the intervention, monetize the impact of the reduction in risky behaviors such as girls were 32% more likely to engage in income generating unprotected sex and teenage pregnancy, these benefits add to activities – and most of this change was due to increased those of the labor market impacts. The difference between the participation in self-employment. costs and the benefits highlight the high rate of return to the ELA program. Health Outcomes Initially, 51% of girls reported that they always used a condom when sexually active, and 11% of the girls had at least one child. With the ELA training on risky behaviors, self-reported routine condom usage increased by 50% among the sexually active, and the probability of giving birth decreased by 26%. Agency and Aspirations Strikingly, the share of girls who reported having had sex against their will over the past year dropped from 21% to almost zero following ELA life skills training, demonstrating a 76% decrease. When asked about their perspectives on CONCLUSION marriage, childbearing, expectations about their children’s lives The struggle to halt the cycle of uninspiring employment and women’s empowerment, the ELA program had opportunities, early marriageand adolescent fertility leading to considerable effects on girls’ perspectives. The girls who were untrained and economically inactive girls in Uganda in the treatment group expected: (1) that their age at first isconsequential. While various approaches to policy reforms marriage was almost one year higher than those in the control are being discussed and tested, the ELA program group; (2) an increase in their ideal age of marriage for men demonstrates the strong positive effects of a combined life and and women in society as a whole; (3) an increase in the livelihood skills training. Though the benefits of the program suitable age for women to have their first child; (4) a decrease outweigh its costs, the question of whether the same resources in the preferred number of children; (5) preference for their could be spent more effectively remains open. However, the daughters to get married at an older age; (6) that the lives of high returns to the program demonstrate its viability as a long- their sons and daughters would be better than their own; (7) term solution. With a 32% increase in the likelihood for participants to engage The World Bank Group | Africa Region Gender Practice Policy Brief: Issue 4 3 in income-generating activities; a 50% increase in self-reported routine condom use by those who were sexually active; a 26% decrease in fertility rates; and a 76% reduction in adolescent girls reporting having had sex unwillingly during the past year, this multi-pronged intervention underscores the importance of testing and scaling up comparable approaches that address the personal agency, health and economic challenges faced by adolescent girls in environments similar to Uganda. Finally, the results also emphasize the need for interventions that will capitalize on the skills of these newly entrepreneurial young women. BRAC has tapped into the talents of this group of adolescent girls in Uganda by introducing a microfinance program. The program offers participating adolescents the opportunities to take on desired credit in order to benefit from their livelihood and self-employment training and abilities. Results from the program will be revealed in the follow-up ELA policy brief. For questions and more information about the Africa Region’s gender program, please contact Katherine Manchester at kmanchester@worldbank.org. The World Bank 1818 H St. NW Washington, DC 20433 USA